Risk Factors And Outcomes Related To The Occurrence Of Acute Kidney Injury After Infra-renal Abdominal Aortic Aneurysm With Chronic Renal Insufficiency

Objective: The current epidemiological data describing infra-renal abdominal aortic aneurysm combined with chronic renal insufficiency postoperative acute kidney injury are limited,The changes in renal function after surgery are largely unknown.Our goal is to understand the incidence of acute kidney injury,risk factors,clinical process and changes in renal function after repair of infra-renal abdominal aortic aneurysm combined with chronic renal insufficiency.Methods: A retrospective analysis of all patients with infra-renal abdominal aortic aneurysm combined with chronic renal insufficiency who underwent surgical treatment in the First Affiliated Hospital of China Medical University from January 2008 to April2019.Collected demographic,clinical,physiological,biochemical and laboratory data.For the preoperative diagnosis and staging of chronic renal insufficiency,we follow the internationally recognized guidelines developed by the American Foundation to determine,Acute kidney injury is defined and classified according to the Acute Kidney Injury Network(AKIN)criteria.Results: A total of 104 patients with chronic renal insufficiency and infra-renal abdominal aortic aneurysm underwent surgical treatment.60.6%(n=63)of patients had acute kidney injury after surgery.Post-operative AKI 1,2 and 3 occurred in 32(30.8%),17(16.3%)and 14(13.5%)cases,respectively.26(25.0%)patients received renal replacement therapy(RRT).Among them,most(n=12,46.2%)patients are in AKI3 stage.Several clinical and biochemical factors are related to the occurrence of acute kidney injury,including baseline glomerular filtration rate(e GFR)<30m L/min/1.73m2(odds ratio [OR] 10.40;95% CI,1.304-82.915,p= 0.008),choose endovascular repair(odds ratio [OR] 0.376;95% CI,0.163-0.867,p=0.02),aortic clamping time in open surgical repair(57.0 vs.73.7,p=0.036),the amount of contrast agent used in endovascular repair(107.6vs.169.7,p<0.001);AKI is associated with a higher likelihood of ICU admission(odds ratio [OR] 4.20;95% CI,1.804-9.794,p=0.001)and the number of days of admission(0.95 vs.4.67,p<0.001);and AKI patients need more RRT treatment(Odds ratio [OR] 0.47;95% CI,0.38-0.60,p=0.034);There were more deaths after surgery(odds ratio [OR] 3.85;95% CI,1.04-14.31,p=0.034).Among 63 patients with AKI,16(25.4%)patients had renal function completely restored to preoperative.In the multivariate analysis,excluding confounding factors,creatinine seventh day after operation(p=0.039),the last creatinine value(p=0.003),the greater AKI severity(p=0.05)and the greater severity of renal insufficiency(p=0.012)were associated with non-recovery.Conclusion: In patients with chronic renal insufficiency,acute kidney injury after surgery is relatively common.Once acute kidney injury occurs,the need for renal replacement therapy and mortality will increase.In this case,a large proportion of AKI patients cannot return to baseline renal function.